Oppenheimer ossicle

Case contributed by Dr Ammar Haouimi

Presentation

Low back pain. No history of trauma.

Patient Data

Age: 40 years
Gender: Male
CT

Bilateral, smoothly well-corticated bony structures located just below the inferior articular processes of L2, and L3.

Disc bulge at L3-L4 and L4-L5.

Hypertrophy of the right L5 transverse process with pseudo articulation with the sacrum in keeping with lumbosacral transitional vertebra (Castellvi type IIa).

Schmorl nodes are noted at the endplates of L2, L3 and L4. 

Annotated image

The green arrows indicate the Oppenheimer ossicles below the inferior articular processes of L2 and L3.

Case Discussion

Oppenheimer ossicles are accessory ossicles, result of the non-union of a secondary ossification center of the articular process. They predominantly occur as a single, unilateral ossicle of the inferior articular processes of the lumbar spine. Usually asymptomatic and discovered incidentally on imaging.

On imaging, the main differential diagnosis is a fracture of the articular process: an Oppenheimer ossicle will demonstrate regular, well-defined corticated margins.

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